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Neuro > (5) Traumatic Brain Injury > Flashcards

(5) Traumatic Brain Injury Flashcards

1
Q

What are the most common acquired brain injuries?

A
  • Stokes
  • Road accidents
  • Falls
  • Tumour
  • Assault
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2
Q

What is traumatic brain injury?

A

An insult to the brain by an external physical force that may produce a diminishes or altered state of consciousness, which results in impairment of physical abilities and/or cognitive function.

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3
Q

What is a contrecoup injury?

A

Are head injuries that most often involve cerebral contusions and traumatic subarachnoid hemorrhage

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4
Q

What is cerebral concussion?

A
  • Shaking of the brain
  • Brief loss consciousness
  • Headache
  • Dizziness
  • Amnesia
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5
Q

What is cerebral contusion?

A
  • Bruise
  • Small haemorrhage
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6
Q

What is cerebral laceration?

A

Tear of cortical surface with contusion

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7
Q

What are the two types of impact damage to the brain?

A
  1. Cortical contusions and lacerations associate with haemorrhage
  2. Diffuse axonal injury involves shearing of axons causing disruption of nerve impulses
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8
Q

What are the different types of secondary brain damage?

A
  • Intracranial haematoma
  • Cerebral swelling
  • Tentorial or tonsillar herniation
  • Cerebral ischaemia
  • Infection
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9
Q

What types of haemorrhage occur post TBI?

A
  • Epidural
  • Subdural
  • Intracerebral
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10
Q

What is brain death?

A

Is when the entire brain, including the brain stem has irreversibly lost function

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11
Q

What are normal vs negative pupil responses?

A
  • Normal the pupil constricts to light
  • Negative there is no change in pupil size
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11
Q

What are tests to determine brain death?

A
  • Pupil response
  • Corneal reflex
  • Absence of VOR
  • Pain test
  • Anoxia test
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12
Q

What is the brain death procedure?

A
  • Carried out by two doctors both with expertise
  • Tests should be repeated 12-24 hours later
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13
Q

What is cerebral perfusion?

A

Blood circulating around the brain at sufficient speed and force to maintain sufficient O2

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14
Q

What is cerebral perfusion influenced by?

A
  • Blood pressure
  • Intracranial pressure
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15
Q

What can cause cerebral ischaemia?

A
  • Hypoxia
  • Decrease in cerebral perfusion
16
Q

What is meningitis?

A

Infection of the meninges

17
Q

What is cerebral abscess?

A

Serious infection of the brain where pus pockets full of infected material form

17
Q

What can lead to infection in the brain?

A
  • Dural tear (CSF leak)
  • Compound depressed fracture
  • Base of skull fracture
18
Q

What are the main objective during the acute phase of TBI?

A
  • Ensure sufficient blood O2 levels
  • Maintain cerebral perfusion pressure
  • Control raised intracranial pressure
  • Keep blood pressure stable
  • Prevent secondary brain damage
19
Q

What are the priorities of assessment for multiple injuries?

A
  • Check airways
  • Breathing (O2 and resp mvmts)
  • Circulation (pulse and BP)
  • Chest/abdominal injury
  • Head/spinal injury (Conscious level)
  • Limb injury
20
Q

What is looked for during assessment?

A
  • period of loss consciousness
  • period of post traumatic amnesia
  • cause and circumstances of injury
  • headache and vomiting
  • evidence of injury
  • pupil response and other cranial nerves
  • Glasgow coma scale
21
Q

What is involved in the Glasgow Coma Scale?

A
  • Eye opening
  • Verbal response
  • Best motor response
21
Q

How is the severity of the injury decided?

A
  • Lowest GCS in first 24 hours
  • Depth of coma/altered consciousness
  • Duration of coma
22
Q

What is post traumatic amnesia?

A

Period from injury until return of day-to-day memory on a continuous basis

23
Q

How is the severity of post traumatic amnesia decided?

A
  • Mild < 1hour
  • Moderate between 1-24 hours
  • Severe 24 hours to 7 days
  • Very severe > 7 days
24
Q

What is the management of TBI in the acute phase?

A
  • Look at ICP and GCS
  • Maintain good cerebral perfusion
  • Prevent secondary brain damage
  • Resp physio as necessary
  • Maintain muscle length
  • Good positioning
25
Q

What does the respiratory treatment in the acute phase involve?

A
  • Maintain good cerebral perfusion
  • Assess resp status
  • O2 sats, ICP, BP, CXR, Ausc
  • Positioning and muscle length
  • Minimize effects spasticity
26
Q

What is other treatment during the acute phase when the patient is stable?

A
  • Functional bed mobility
  • Watch tendon achilles closely for signs shortening
  • Early standing, sitting
  • Care of airway & other tubes
27
Q

What can brain stem swelling/damage lead to?

A

Rigidity

28
Q

What are the different stages of recovery?

A
  • Agitation
  • Aggression
  • Becoming aware of injuries
  • Possible depression
29
Q

What effects does TBI have on motor function?

A
  • Spasticity
  • Hyperreflexia
  • Abnormalities of mvmt and posture
  • Trunk/limb weakness
  • Tremor
  • Incoordination
  • Dysphagia & Dysarthria
  • Incontinence
  • Epiliepsy
  • Fatigue
  • Heterotrophic ossification
30
Q

What are some cognitive, behavioural and psychological problems associated with TBI?

A
  • memory
  • confusion
  • poor judgement & reasoning
  • personality changes
  • disinhibition & impulsiveness
  • emotional liability
  • perceptual deficits
  • depression
  • language deficits
  • economic and social impact
31
Q

What is involved in management of a subacute TBI?

A
  • Thorough assessment
  • Head control, sitting and standing balance
  • Problem list
  • Short and long term goals
  • MDT N.B
32
Q

What are the aims of treatment in rehab phase?

A
  • normalise tone
  • facilitate normal movement
  • sensory stimulation
  • communicate with family
  • restore function
  • consider effects cognitive problems
  • restore physical fitness
  • behavioural modification
  • continuous evaluation
33
Q

What are some discharge considerations?

A
  • Home support
  • Community services
  • Headway Ireland
  • Vocational retraining
  • Long-term neurological difficulties

Neuro (11 decks)

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